Provider Demographics
NPI:1275541450
Name:LEDET, SUSAN JEANNE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEANNE
Last Name:LEDET
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30467
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3467
Mailing Address - Country:US
Mailing Address - Phone:405-733-3133
Mailing Address - Fax:405-869-7165
Practice Address - Street 1:1212 S AIR DEPOT BLVD
Practice Address - Street 2:SUITE 33
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4870
Practice Address - Country:US
Practice Address - Phone:405-733-3133
Practice Address - Fax:405-869-7165
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist